LANDER COUNTY SCHOOL DISTRICT

LICENSED EMPLOYEE APPRAISAL REPORT

Employee's Name: _______________________________________	School/Location:_______________________________

Social Security No.: _______________________ Assignment: ______________________	Years in Lander Schools: _____________

Observation Dates: From _________________ to _________________ Conference Date: _________________	Page 1 of ______

Report and analysis of observations, performance, and other factors which may be pertinent to performance; probationary/postprobationary status, date of last evaluation and directions.

LEVELS OF PERFORMANCE
Level 4	Performance exceeds standards consistently at a distinguished level.	Level 2	Performance approaches standards and/or does not consistently meet standards.
Level 3	Performance consistently meets standards and may occasionally exceed standards in some areas.	Level 1	Performance is below standards and is not satisfactory.
PROFESSIONAL DOMAINS
PLANNING AND PREPARATION	4	3	2	1

INSTRUCTION (continued)	4	3	2	1
PROFESSIONAL STANDARDS	3. Lessons had a clearly defined structure and pacing was appropriate.
1. Instructional planning was documented in written lesson plans and based on adopted curriculum documents and standards.	4. Flexible instructional groupings were utilized.
5. Accommodations and/or modifications were used in alignment with instructional objectives to meet the needs of students.
2. Content knowledge was demonstrated in planning.
3. Planning reflected knowledge of student achievement, access/equity, students' interests and backgrounds, and other site-specific demographic data.	6. Feedback to students was provided and promoted student success and achievement.
PROFESSIONAL RESPONSIBILITIES	4	3	2	1
ASSESSMENT OF STUDENT ACHIEVEMENT	4	3	2	1	PROFESSIONAL STANDARDS
PROFESSIONAL STANDARDS	1. The employee participated in the school improvement process and implemented school improvement goals.
1. Student achievement, access/equity, and other site specific demographic data were analyzed.	2. The employee addressed identified individual improvement goals/directions.
2. Desired results for student learning/achievement were identified, measurable, and used for instructional planning to determine and monitor student progress.	3. The employee participated in on-going professional development to improve content knowledge and pedagogical skills.
3. Assessment regulations and guidelines were followed.

4. The employee participated in required job-related meetings and activities and performed assigned duties.
LEARNING ENVIRONMENT	4	3	2	1	5. The employee maintained student records.

PROFESSIONAL STANDARDS
1. An academic focus and on-task behavior were maintained.	6. The employee provided communication to parents/ guardians and students related to behavior and achievement.

2. A classroom management/discipline plan was in place, communicated and maintained.
3. Respect and courtesy were modeled by the teacher in student and parent interactions.	7. The employee worked professionally with administration, staff, parents, and community.
4. The physical environment supported the teaching/learning process.	8. The employee used multicultural resources, materials and activities to support multicultural literacy, awareness, and appreciation.
INSTRUCTION	4	3	2	1	9. The employee complied with all school and district policies and regulations, as well as state and federal laws applicable to teachers.
PROFESSIONAL STANDARDS
1. The components of an effective lesson and the basic principles of learning were used when providing instruction.	A narrative, which includes a PERFORMANCE SUMMARY and IMPROVEMENT GOALS/DIRECTIONS, must be included on the following page(s).
2. Varied instructional strategies, approaches, and resources, aligned with instructional objectives, engaged students in learning.
Overall performance rating of unsatisfactory will require additional documentation.

I certify that I have supervised and evaluated the professional performance of the above named probationary postprobationary employee,

and I certify that to date this school year his/her overall performance is satisfactory is not satisfactory.

___________________________________________________________________	___________________________________________________________________

Signature of Employee†	Date	Signature of Supervising Administrator	Date

†Your signature indicates you have received the evaluation form and not that you necessarily agree with the evaluation.

LANDER COUNTY SCHOOL DISTRICT

LICENSED EMPLOYEE APPRAISAL REPORT NARRATIVE

Name	SS#	Date	Page No. of

PERFORMANCE SUMMARY

___________________________________________________________________	___________________________________________________________________

Signature of Employee†	Date	Signature of Supervising Administrator	Date

†Your signature indicates you have received the evaluation form and not that you necessarily agree with the evaluation.

LANDER COUNTY SCHOOL DISTRICT

LICENSED EMPLOYEE APPRAISAL REPORT NARRATIVE

Name	SS#	Date	Page No. of

IMPROVEMENT GOALS/DIRECTIONS

___________________________________________________________________	___________________________________________________________________

Signature of Employee†	Date	Signature of Supervising Administrator	Date

†Your signature indicates you have received the evaluation form and not that you necessarily agree with the evaluation.

LANDER COUNTY SCHOOL DISTRICT

PERSONNEL RECORD - CONTINUATION SHEET

Name	SS#	Date	Page No. of

___________________________________________________________________	___________________________________________________________________

Signature of Employee†	Date	Signature of Supervising Administrator	Date

†Your signature indicates you have received the evaluation form and not that you necessarily agree with the evaluation.